Organization Active NPI

Ondrej Chudoba, M.D., S.C.

  • Psychiatry Physician
  • Huntley, IL
National Provider Identifier
1154498533
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
ONDREJ CHUDOBA, M.D., S.C.
Practice address
11317 Smith Dr
11924 Oak Creek Parkway
Huntley, IL 60142-9602
Phone
(847) 515-8131
Fax
(847) 515-8142
NPI assigned
Nov 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ondrej Chudoba, M.D.NPI 1285724906
Title
President
Phone
(630) 415-3087

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X IL Primary

Addresses

Primary practice location

11317 Smith Dr
11924 Oak Creek Parkway
Huntley, IL 60142-9602

Mailing address

11317 Smith Dr
11924 Oak Creek Parkway
Huntley, IL 60142-9602
Phone (847) 515-8131

Other identifiers 1

IdentifierTypeStateIssuer
1627496OtherILBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

1541 Clinton Pl
River Forest, IL 60305
Phone (630) 415-3087

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154498533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11317 SMITH DR",
            "address_2": "11924 OAK CREEK PARKWAY",
            "city": "HUNTLEY",
            "state": "IL",
            "postal_code": "601429602",
            "telephone_number": "847-515-8131",
            "fax_number": "847-515-8142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11317 SMITH DR",
            "address_2": "11924 OAK CREEK PARKWAY",
            "city": "HUNTLEY",
            "state": "IL",
            "postal_code": "601429602",
            "telephone_number": "847-515-8131",
            "fax_number": "847-515-8142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ONDREJ CHUDOBA, M.D., S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHUDOBA",
        "authorized_official_first_name": "ONDREJ",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-415-3087",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1627496",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntley, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.